Chapter 15

What diets are the easiest and most preferred method of providing nutrition?

oral diets

What are the three types of oral diets?

"regular", modified consistency, or therapeutic

What is a diet as tolerated or DAT?

this is on admission or after surgery and it is interpreted according to the patient's appetite and ability to eat and tolerate food.

What to modified consistency diets have in them?

clear liquid and mechanically altered diets; may be used after surgery or in preparation for surgery

Most patients can tolerate a _____ diet for their ______ postop meal, after their first meal of clear liquids.

regular; second

What is a mechanically altered diet?

it contains foods that are chopped, ground, pureed, or soft for patients who have difficulty chewing or swallowing

What is a dysphagia diet?

another variation of modified consistency diets

What are therapeutic diets?

differ from a regular diet in that they have a special amount of one or more nutrients or food components for the purpose of preventing or treating disease or illness

When should nutritional supplements be given?

when patients are unable or unwilling to eat enough food to meet their requirements, either because intake is poor or because their nutritional needs are so high that it is difficult to meet requirements in a normal volume of food

What is a modular product?

composed of a single nutrient, either carb, protein or fat and increase calorie or nutrient density of the diet without increasing volume

What is enteral nutrition?

the delivery of nutrients by tube, catheter, or stoma into the GI tract beyond the oral cavity; commonly known as tube feeding

______ _______ may augment an oral diet or may be the sole source of nutrition.

enteral nutrition (EN)

When is enteral nutrition contraindicated?

when the GI tract is nonfunctional as in diffuse peritonitis, gastric or intestinal obstruction, paralytic ileus, intractable vomiting, severe diarrhea, and GI ischemia

________ nutrition is significantly less costly than ______ nutrition.

they are the most common; they are feeding tubes that extend from the nose to either the stomach or the small intestine; they are used for a short duration (<3-4 weeks)

What is an Ostomy? How long is it used?

it is a surgically created opening (stoma) made to deliver feedings directly into the stomach or intestines; preferred for permanent or long-term feedings because they are hidden under clothing and do NOT cause irritation to the mucous membranes

What is Percutaneous Endoscopic Gastrostomy (PEG) tubes? How long are they used for?

a feeding tube placed through an opening in the stomach made surgically or under local anesthesia with the aid of an endoscope; long term

What are the two categories of enteral formulas?

standard formulas; hydrolyzed

What is a standard enteral formula? Who uses these formulas?

tube-feeding formulas that contain whole molecules of protein; also known as intact or polymeric formulas; contain protein isolates and used for patients who have normal digestive and absorptive capacity

How much protein do standard formulas usually contain?

34-43 g of protein per liter

What are hydrolyzed formulas and partially hydrolyzed formulas?

they only contain free amino acids as their source of protein; partially hydrolyzed formulas contain proteins that are broken down into small peptides and free amino acids

What patients need hydrolyzed formulas?

patients with impaired digestion or absorption, such as people with inflammatory bowel disease, short-gut syndrome, cystic fibrosis, and pancreatic disorders

How many calories do routine formulas provide?

1-1.2 cal/mL

How many calories do high calorie formulas provide?

1.5-2.0 cal/mL

A patient who needs 2000 calories can meet her or his calorie needs with ______ mL of a _____ cal/mL formula. But if that patient is volume or fluid-restricted, a better option is _______ mL of a ____ cal/mL formula

2000 of a 1.0cal/mL; 1000 of a 2.0cal/mL

How much water does a formula that provides 1 cal/mL provide?

850 mL of water per liter

How much water does a high calorie formula provide?

690-720 mL/L of water

How much water do adults generally need per day?

30-40 mL/kg/day of water

Do patients receiving EN need extra water?

yes, they get "free" water to meet fluid requirements; it is administered when water is used to flush the tube and as a bolus administration

What combines with undigested food and intestinal secretions to make residue?

fiber

What type of formula is residue free?

hydrolyzed formulas

What are blenderized formulas? How many grams of fiber do they usually provide?

natural source of fiber because they are made of whole foods; they provide 4 g of fiber per liter

What is osmolality determined by in enteral formulas?

the concentration of sugars, amino acids, and electrolytes

What are isotonic formulas?

they have approximately the same osmolality as blood and are well tolerated

The more _______ the protein is, the greater the osmolality, thus _______ formulas are higher in osmolality than ________ formulas.

digested; hydrolyzed; standard

Some patients develop diarrhea when a ________ formula is infused into the small intestine.

hypertonic

High fiber formulas have a _____ ______.

high viscosity (therefore need a larger tube)

What are intermittent feedings? Who are they used for?

administered throughout the day in equal portions of 250 to 300 mL of formula over 30-60 minutes every 4-6 hours; used for noncritical patients, home tube feedings or patients in rehab

What is a gastric residual?

the volume of feeding that remains in the stomach from a previous feeding

What are bolus feedings? What can they cause?

a variation of intermittent feedings and a rapid administration of a large volume of formula; used only for feedings to the stomach

-can cause "dumping syndrome"

What is the continuous drip method? Who is it used for?

they are given at a rate over 16- 24 hour period of time to maximize tolerance and nutrient absorption; used for critically ill clients

Continuous feedings should be interrupted every ____ hours so that water can be infused into the line to clear the tubing and hydrate the client/

4 hours

What are cyclic feedings?

a variation of continuous drip feedings that deliver a constant rate of formula over 8- 12 hours, often during sleeping hours

What are the four types of EN feedings?

intermittent; bolus; continuous drip; cyclic

How should you prepare a patient for a tube feeding?

elevate the patients upper body to at least a 30 degree angle during feeding and for at least 30 minutes afterward to reduce the risk of aspiration

How are tube feedings initiated?

at full strength

What is the recommended max flow rate for gastric feedings?

125 mL/hour

What is the max flow rate for small bowel feedings ?

determined by individual tolerance

What is the most serious complication with EN?

aspiration

When should medications be given if the patient is on EN?

after the feeding, make sure the tube is flushed before and after the drug is given

When should tube feedings decrease to only during the night time?

when oral calorie intake is 500 to 700 cal/day

When should tube feedings be completely discontinued?

when patient consistently consumes two-thirds of protein and calorie needs orally for 3-5 days, the tube feeding may be totally discontinued

What is parenteral nutrition? (PN)

the delivery of nutrients by vein; or outside the intestinal tract

What patients use PN?

patients who have non-functioning GI tracts

What is refeeding syndrome?

a potentially fatal complication that occurs from an abrupt change from a catabolic state to an anabolic state and an increase in insulin caused by a dramatic increase in calories